Call In Event Survey

Thank you for calling tonight. 

Before I assist you, I need to notify you of our privacy policy and what we will do if we need to collect information from you. For some assistance, I will need to collect some personal information from you. For example, if you want a customized personal resource directory that will be mailed to you at a later date, I would need your name and address. Also, we will enter the information into our tool that helps us track how many requests we get. Your personally identifiable information will not be shared with anyone outside of the Senior LinkAge Line® system but it may be used to send a customer satisfaction survey.  Do you give me permission to continue?

Food Shelf/Pantry (SEARCH - Food Pantries)
Congregate Meals (SEARCH - Congregate Meals)
Home Delivered Meals (SEARCH - Home Delivered Meals)
Grocery Delivery (SEARCH - Grocery Delivery)
Rides to grocery store or the doctor (transportation) (SEARCH - Senior Ride Programs)
Transportation Payment Assistance (SEARCH - Transportation Expense Assistance)
Health Insurance Premiums Assistance (SEARCH - Medicare Savings Programs)
Help to Understand Medical Bills (SEARCH - Health Insurance Information/Counseling)
Prescription Drug Payment Assistance (SEARCH - Prescription Drug Patient Assistance Programs)
Utilities Assistance (SEARCH - Utility Assistance)
Housing, low income/subsidized (SEARCH - Low Income/Subsidized Private Rental Housing)
Indoor chores (SEARCH - Homemaker Assistance)
Outdoor chores (SEARCH - Yard Work)

If caller has many needs, refer to the county of residence for a Long Term Care Consultation. County Long Term Care Consultation phone numbers.

First and Last Name*